Laserfiche WebLink
&PPLICATION FOR ENCROACHMENT PERMIT <br /> PLSASS PRINT: � 7 917 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE �� - <br /> C���FORNIR �! ATtt� S .�V e VALID• ` -10- P, TO -/S- 08 . DRIVEWAYS: <br /> . r �-(pAppl.icagTn�t Name) STREET <br /> . 550\W , \ 1� M s7 -W\cQ AREA `_�t�t.�C�`o QUAD ht; _ <br /> TYPE BCH L.� <br /> (Mailing .Address) ry FORMS <br /> @O 3 NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telephone Number). <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to.excavate, construct and/or <br /> otherwise-encroach•on County Highway Right-of-Way-on•the .\NQP7--'�k- • side�,.bf .. • - _ • - <br /> ��5 approximately S C) ` ee mile "LKST- <br /> of by-per€ormin.g the <br /> followin work (description of work) : <br /> C, U17, T,i u- SSCA <br /> Nzis <br /> Work will commence on or'about for approximately <br /> �o€� days. <br /> I, the undersigned certify- that I am the owner, of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in , <br /> accordance with the rul.Ts, regulations*of San Joaquin County and subject to <br /> inspection and approval,�,p`1-0-1-1: <br /> Signature of Applicant - Title Date <br /> HXTMA.PS\Pffi®L (GAG) , <br /> i <br />